Bikur Cholim II
Rabbi Kaganoff
Bikur Cholim II
By Rabbi Yirmiyohu Kaganoff
Question #1: Only visiting?
Is bikur cholim fulfilled simply by visiting the sick?
Question #2: How often?
How many times a day can one perform bikur cholim?
Question #3: Focus!
Do I need to focus that I am doing the mitzvah in order to fulfill it?
Foreword
In a previous article, we studied the laws of bikur cholim. We learned there that the original meaning of “bikur” is “examining” or “checking” and that the primary responsibility of the mitzvah of bikur cholim is to check and see what the ill person needs and to do whatever one can to meet those needs (Toras Ha’adam of the Ramban).
Many people err to think that the mitzvah of bikur cholim is simply to visit the ill and cheer them up, but do not realize that the mitzvah includes attending to the ill person’s needs and praying on their behalf.
The previous article also taught that mitzvos tzerichos kavanah, performing a mitzvah requires being aware that what I am doing is something that Hashem commanded. Therefore, when I focus that this action fulfills a mitzvah, I gain reward that I do not receive if I do not pay attention that what I am doing is a mitzvah. It is also true that I can accomplish bikur cholim even if I am paid to perform the mitzvah. For this reason, a medical professional gains much merit by being aware that he is performing a mitzvah each and every time that he inquires about someone ill and assists in their care. One who does these same activities as a job, without considering that he is carrying out Hashem’s mitzvah, loses the opportunity to fulfill it and to receive reward.
The previous article noted that there are several allusions in the Torah to the mitzvah of bikur cholim. It also discussed the dispute whether bikur cholim is counted separately as one of the 613 mitzvos or is subsumed under the mitzvah of following in Hashem’s ways. To quote the Gemara (Sotah 14a): Rabbi Chama the son of Rabbi Chanina said: “How are we to understand the words of the Torah, ‘You should follow Hashem, your G-d’ (Devarim 13:5)? How is it possible for a human being to follow the Holy One, blessed is He, when the verse states that ‘Hashem, your G-d, is a consuming fire? (Devarim 4:24; 9:3)’ Rather, it means that we are to emulate Hashem’s attributes – just as he dresses the unclothed… takes care of the sick… so should we!”
Similarly, the Torah teaches, “You must clarify to them [your children] the laws and the teachings, and make known to them the pathways in which they are to walk and the deeds that they are to perform” (Shemos 18:20), which the Gemara (Bava Kama 100a) explains includes gemillas chessed, bikur cholim and other, similar, acts of kindness.
The Toras Ha’adam writes, “It is a great mitzvah to visit the ill, since this causes the visitor to pray on the sick person’s behalf, which revitalizes him. Furthermore, since the visitor sees the ill person, the visitor checks to see what the ill person needs” (also see Beis Yosef, Yoreh Deah 335). We see that praying for the ill is an even greater part of the mitzvah than attending to his needs, since the Ramban first mentions praying and then refers to attending to the other needs of the ill as “Furthermore.”
When praying in the presence of the individual, one can pray for his recovery in any language and does not need to mention their name. By the way, wishing the patient a refuah sheleimah is considered praying for the individual. The authorities note that someone who visits a sick person without praying for his recovery has not fulfilled all the requirements of the mitzvah (Toras Ha’adam, based on Nedarim 40a; Rema, Yoreh Deah 335:4). Therefore, medical professionals should accustom themselves to pray for their sick patients, in order to fulfill the complete mitzvah of bikur cholim.
When praying for someone ill, always include a request that the rest of the Jewish ill also recover (Shabbos 12b).
The Gesher Hachayim recommends reciting the following pesukim as an introductory prayer for the patient: The pasuk that begins with the words Veheisir Hashem mi’mecha kol choli (Devarim 7:15), the pasuk Im shamoa…kol hamachalah asher samti bemitzrayim lo asim alecha ki ani Hashem rofe’echa (Shemos 15:26) and Borei niv sefasayim… amar Hashem urefasiv (Yeshayahu 57:19).
Changing the name
Based on a passage in the Gemara (Rosh Hashanah 16b), the Rema suggests changing the patient’s name (Yoreh Deah 335:10), a practice usually followed only when the patient is facing a very serious situation. When “changing” the patient’s name, the common practice is to add a name, such as Chayim, Chayah or Refael, at the beginning of the patient’s name. The Gesher Hachayim (Volume 1, 1:3:5) advises that the new name should always be added at the beginning – if the patient’s name had been Moshe ben Sarah, the new name is Refael Moshe ben Sarah, and if it was Rivkah bas Leah, the new name is Chayah Rivkah bas Leah.
If the patient improves even slightly and survives for thirty days after their name has been changed, this new name should be considered their name permanently and is also used when children are called up for an aliyah, when making a mishebeirach or other tefillah purposes. If the patient shows no improvement after the name is changed or passes away within thirty days of the name change, we ignore the changing of the name, both for the ill, now deceased, person and for their progeny.
For clarification, I will use two actual examples. During my mother’s final illness, she contracted a different, very severe condition, and the name Chayah was added at the beginning of her name, Shterna Baila. She recovered from this condition, although her primary illness took her life a little more than a year later. Her name remains Chaya Shterna Baila.
When my father was diagnosed with terminal cancer, the name Chayim was added before his name. Although he lived another three months, there was no improvement during this time, and therefore his name is Menachem Nachum, without the additional Chayim at the beginning.
How to change?
Some siddurim and the Gesher Hachayim suggest procedures to be followed for the name changing. Gesher Hachayim suggests that a quorum recite eighteen chapters of Tehillim (see page 31 of Volume I of his work for the list of chapters that he recommends), then selections from Chapter 119 of Tehillim, and then a special tefillah. If a minyan is present, he advises to then recite the 13 attributes of mercy of Hashem (Shemos 34:6, 7).
Small patient
One of the greatest acts of chesed is to stay overnight with a choleh (Aruch Hashulchan, Yoreh Deah 335:3; Shu’t Tzitz Eliezer, Volume 5, Ramat Rachel, #4; Yalkut Yosef, Volume 7, page 27). A similar act of pure bikur cholim and true chesed is to stay overnight with a hospitalized child, which, in addition to fulfilling all aspects of bikur cholim enables the overburdened parents to get some proper sleep and attempt to keep their family’s life in order at a very stressful time.
The Gemara (Nedarim 39b) states that the mitzvah of bikur cholim has no limit. The concluding interpretation of that Gemara is that this means that a person can fulfill the mitzvah of bikur cholim even a hundred times a day. If one frequently pops one’s head into a sick child’s bedroom to see how the child is doing, or periodically drops in to visit a shut-in, one fulfills a separate mitzvah each time, so long as it does not become burdensome to the choleh. As I mentioned in the previous article, a nurse fulfills the mitzvah of bikur cholim each time he/she checks on a patient.
Every community should have an organization devoted to the needs of the sick, and it is a tremendous merit to be involved in organizing and participating in such a wonderful chesed project (Ahavas Chesed 3:3).
The Gemara (Nedarim 40a) reports that when one of Rabbi Akiva’s disciples was ill, no one came to check the patient’s welfare. Rabbi Akiva entered the uncared-for dwelling, cleaned it and sprinkled water on the dirt floor (to prevent dust from rising). The student proclaimed, “Rabbi Akiva, you have brought me back to life!” After this experience, Rabbi Akiva taught that someone who visits the ill is considered as if he saved the person’s life!
The Gemara states that someone who fulfills the mitzvah of bikur cholim is saved from the judgments of Gehenna (Nedarim 40a).
Taking care of needs
In addition to raising the sick person’s spirits by showing one’s concern, the visitor should also ascertain that the physical, financial, and medical needs are properly cared for, as well as other logistical concerns that may be troubling the patient. The mitzvah is to identify what the ill person needs to have taken care of and attend to that. If he needs to have household jobs attended to, getting kids to school, or financial help while the breadwinner is ill, these are all aspects of fulfilling the mitzvah of bikur cholim. Often, well-meaning people make the effort to visit the sick, but fail to fulfill the mitzvah of bikur cholim fully, because they fail to check if the choleh needs something (Gesher Hachayim).
When to visit
The Gemara (Nedarim 40a) says that one should not visit a choleh at the beginning of the day or at the end. This ruling is cited by the Toras Ha’adam and many other early halachic authorities. Despite the above, the custom is to visit the ill person, regardless of the time of the day. Why is this so? The Aruch Hashulchan (Yoreh Deah 335:8) explains that the Gemara’s visiting times are advisory rather than obligatory. The Gemara is saying that one should visit the ill person at the time most beneficial for his care, which is usually the afternoon, either because this does not interfere with medical care or because it is the best time to detect the patient’s medical status. However, this is only advice and can be tempered by other practical concerns.
How to visit
The Gemara states that the shechinah rests above the head of a sick person (Shabbos 12b; Nedarim 40a). For this reason, it states that someone who visits a sick person should not sit on a bed, a stool or a chair, but on the floor. Alternatively, he can remain standing during his visit.
However, the Ran (Nedarim 40a) and the Rema (Yoreh Deah 335:3) rule that when the Gemara prohibits sitting on a bed, a stool or a chair when visiting someone ill, it is referring to a situation where the patient is lying on the floor – in such a situation, one should not sit higher than the shechinah. When the ill person is in a bed, one can sit on a chair that is no taller than the bed (see Yalkut Yosef, page 28, quoting Rav Eliezer Yehudah Valdenberg).
Based on a Zohar (parshas Pinchas), some contend that one should not sit near the head or the foot of the ill person, but alongside him (Beis Hillel and Shiyurei Beracha, Yoreh Deah 335:3). This ruling is alluded to also in the She’iltos.
Incidentally, since the Shechinah is in the choleh’s presence (Shabbos 12b), visitors should act in a dignified manner (Shela”h). This includes both their behavior and their mode of dress.
Visiting on Shabbos
The Gemara quotes a dispute between Beis Shammai and Beis Hillel whether it is permitted to visit someone ill on Shabbos (Shabbos 12a). Beis Shammai rules that one should not. Among the reasons suggested for Beis Shammai’s opinion is that this may cause the visitor to become sad on Shabbos upon seeing the suffering of the ill (Rashi), that this violates the mitzvah of oneg Shabbos (She’iltos), or that this might cause someone to pray on Shabbos for a personal request, which is prohibited (Shevet Yehudah, Yoreh Deah 335:6). Even according to Beis Hillel, who permit doing bikur cholim on Shabbos, the Gemara says that bikoshi hitiru, this was permitted only with difficulty. Based on this, the Magen Avraham (287) disapproves of those who perform bikur cholim only on Shabbos, noting that although permitted, it is preferred that bikur cholim be performed on weekdays. The Sha’arei Teshuvah and the Biur Halacha note that someone who does not have time except for Shabbos may go, and certainly so if he thereby provides encouragement and creates smiles on people’s faces.
The Shulchan Aruch (Orach Chayim 287:1) concludes that it is permitted to perform bikur cholim on Shabbos, like Beis Hillel, but emphasizes that one should not bless the ill person with the same refuah sheleimah wishes that are said on weekdays. This is presumably because wishing refuah sheleimah is actually a prayer on the ill person’s behalf, and Chazal prohibited reciting personal requests on Shabbos. The Gemara quotes several opinions concerning exactly what you should say to the ill person on Shabbos. The last two opinions mentioned are those of Rabbi Yosi and of Shevna (or Shachna) of Yerushalayim. Rabbi Yosi cites a simple text, Hamakom yeracheim alecha besoch cholei Yisrael, “Hashem should have mercy on you among the other ill people of Israel.” Shevna’s text is: Shabbos hi miliz’ok urefuah kerovah lavo verachamav merubin vishivsu beshalom, “Shabbos is here; therefore one should not cry out in pain. Healing comes quickly; Hashem’s mercy is great; Dwell in peace!” This means that it is prohibited to scream out in prayer on Shabbos, but the curtailed prayer I am currently reciting should be viewed by Hashem as if I indeed recited a very intense prayer on behalf of the ill and the cure should arrive soon. Some authorities follow Rabbi Yosi’s opinion (Toras Ha’adam; Shulchan Aruch, Yoreh Deah 335:6) whereas the Shulchan Aruch itself, in Orach Chayim, cites Shevna’s text. The Rema writes that the custom is not to add the extra words of Shevna’s prayer, but to say simply Shabbos hi miliz’ok urefuah kerovah lavo.
Yom Tov
May one wish a person refuah sheleimah on Yom Tov, or does it have the same halacha as Shabbos. In general, Ashkenazic practice is to be more lenient regarding the laws of personal prayers on Yom Tov than on Shabbos. For this reason, we recite the 13 middos of Hakadosh Boruch Hu when we take out the sefer Torah on Yom Tov, followed by a personal prayer. Yom Tov is more lenient than Shabbos regarding the prohibition of reciting a personal prayer because each Yom Tov is a day of judgment for something, as the Mishnah states in Rosh Hashanah (16a): On Pesach, we are judged for grain; on Shavuos, for fruit; and on Sukkos, for water.
As a result of this discussion, there is a dispute between the Mekor Chayim and the Aderes whether it is permitted to wish a choleh refuah sheleimah on Yom Tov, the Mekor Chayim ruling that one should use the same version used on Shabbos, and the Aderes permitting wishing refuah sheleimah, which is not usually permitted on Shabbos.
Beracha
If bikur cholim is such an important mitzvah, why do we not recite a beracha prior to performing it? This question is raised by the rishonim, who provide several answers:
1. One recites a beracha only prior to a mitzvah that I am certain that I will be able to perform. The patient may not want to be visited or may not want other people to take care of matters for him, in which case there is no mitzvah of bikur cholim (Shu”t Harashba #18).
Not uniquely Jewish
2. Some authorities explain that we do not recite a beracha on this mitzvah because the text of birchos hamitzvos is Asher kideshanu bemitzvosav -- Hashem sanctified us with His mitzvos. These authorities contend that we recite a beracha only when a mitzvah is uniquely Jewish (Rokei’ach, quoted in Encyclopedia Talmudis, Volume IV, column 525). Since non-Jews also take care of the ill, this mitzvah does not reflect anything special about the relationship of Hashem to the Jewish people.
3. Yet another reason cited why we do not recite a beracha on bikur cholim is because reciting a beracha prior to observing this mitzvah sounds like we want the situation to exist (Ra’avad, quoted by Yalkut Yosef, page 24). We certainly would prefer that there be no ill people in the world.
4. Some rishonim note that all mitzvos upon which we recite berochos are those bound by time – meaning that there are times when we are obligated to observe the mitzvah and times when no obligation exists (Or Zarua, Birchas Hamotzi #140). Bikur cholim can be fulfilled at any time.
Conclusion
People who fulfill the mitzvah of bikur cholim are promised tremendous reward in Olam Haba, in addition to many rewards in this world (Shabbos 127a). The Kli Yakar (Bamidbar 16:29) suggests an additional reason for fulfilling bikur cholim -- to benefit the visitor -- because seeing someone who is ill influences the visitor to do teshuvah. This provides extra merit for the sick person, since he caused someone else to do teshuvah, even if it was unintentional. May Hashem send a speedy recovery to all the ill!